Reduction Of Pain Through Lower Fluence Rates And Longer Treatment

ABSTRACT

An apparatus for treatment of a subcutaneous fat region includes a source of electromagnetic radiation generating electromagnetic radiation having a non-fat selective wavelength. A delivery system is coupled to the source of electromagnetic radiation and is configured to deliver the electromagnetic radiation to the subcutaneous fat region for at least 300 seconds. A controller is configured to adjust an average power density based on a thickness of skin overlying the subcutaneous fat region, and to cause necrosis of at least one fat cell in the subcutaneous fat region. The non-fat selective wavelength is 950 nm to 1090 nm, 1100 nm to 1160 nm, 1,300 nm to 1625 nm, or 1,800 nm to 2,200 nm.

CROSS REFERENCE TO RELATED APPLICATIONS

This application is a division of U.S. application Ser. No. 14/943,265filed on Nov. 17, 2015, which is a division of U.S. application Ser. No.13/110,850 filed on May 18, 2011, now U.S. Pat. No. 9,308,046, issued onApr. 12, 2016, which claims the benefit of and priority to U.S.Provisional Application No. 61/345,834 filed May 18, 2010, which isowned by the assignee of the instant application and the disclosure ofwhich is incorporated herein by reference in its entirety.

FIELD OF THE INVENTION

The invention relates generally to a process and system for deliveringlaser radiation to skin as a means for selectively heating subcutaneousfatty tissue, and more particularly, to causing thermal injury tosubcutaneous fatty tissue without the need for anesthetics and withoutcausing intolerable pain to the subject.

BACKGROUND OF THE INVENTION

Prior work has shown selective laser damage to subcutaneous fat withoutcausing severe dermal damage or scarring. Using a 1210 nm near-infrared(NIR) diode laser, prior study has found an optimum fat selective doseof 80 J/cm² based on a 10 mm spot size, 3 s exposure and contactcooling. Even though the laser treatments are safe, they are alsopainful. In continuing to optimize 1210 nm NIR laser for the treatmentof cellulite and fat reduction, the treatment beam diameter wasincreased to 40 mm and the pulse duration was increased to 40 s. Tissueviability studies of freshly excised porcine and human skin using thesetreatment parameters found laser doses between 140-180 J/cm² were neededto obtained sufficient thermal damage to subcutaneous fat while avoidingdamage to the epidermis and dermis. These parameters can be too painfuland not easily tolerated by subjects.

Other treatments of subcutaneous fat are ineffective and can causeadverse effects. For example, U.S. Pat. No. 7,351,252 to Altshuler etal. (“Altshuler”) describes treating a desired region of tissue byapplying optical radiation to reach the depth of the region. Treatmentregions disclosed by Altshuler include the reticular dermis region, thedermis-subcutaneous fat junction, and the subcutaneous fat region. Foreach of the three regions, Altshuler discloses a set of treatmentparameters, including radiation exposure time and power density, thatare used when pre-cooling is applied to the surface of the skin and adifferent set of parameters when treatment is performed without surfacepre-cooling. FIG. 1 shows a diagram of treatment parameters disclosed byAltshuler when pre-cooling is not applied, the skin surface is cooled to5° C. during radiation treatment and the laser wavelength is about1.15-1.23 nm. The area 102 represents the range of radiation exposuretime (2-65 s) versus the range of power density (2.5-50 W/cm²) disclosedby Altshuler for treating the reticular dermis region (1-3 mm depth) andthe dermis-subcutaneous fat junction (2-5 mm depth). The area 106represents the range of radiation exposure time (65-270 s) versus therange of power density (0.5-20 W/cm²) disclosed by Altshuler fortreating the subcutaneous fat region (5-10 mm depth).

Studies have shown that more than 75% of the areas 102 and 106 taught byAltshuler are ineffective and/or can cause adverse skin effects. In FIG.1, the solid curve 110 represents the lower bound of the therapeuticrange for which treatment is effective. The solid curve 114 representsthe upper bound of the therapeutic range for which treatment iseffective. The solid curves 110 and 114 were calculated based on athermal model of the skin and clinical results.

As shown by FIG. 1, a large portion of each of the areas 102 and 106 isoutside of the effective treatment zone bound by the curves 110 and 114.In particular, portion 102 a of the area 102 below the curve 110indicates ineffective parameters for treating the reticular dermisregion and the dermis-subcutaneous fat junction according to Altshuler.Portion 102 b of the area 102 above the curve 114 indicates harmfulparameters for treating the reticular dermis region and thedermis-subcutaneous fat junction according to Altshuler. Similarly, inthe area 106, portion 106 a below the curve 110 indicates ineffectiveparameters for treating the subcutaneous fat region according toAltshuler. Portion 106 b above the curve 114 indicates harmfulparameters for treating subcutaneous fat region according to Altshuler.Therefore, based on the teachings of Altshuler, a practitioner cannotdiscern the effective therapeutic range for treating different regionsof tissue and is likely to provide ineffective or adverse treatment as aresult. Adverse effects can include minor epidermal blistering to moresevere full-thickness skin burns and ulcerations.

SUMMARY OF THE INVENTION

The invention, in various embodiments, features treatments ofsubcutaneous fat in biological tissue. A treatment can causepain-tolerant necrosis in subcutaneous fat region of the tissue, therebyreducing the number of fat cells in the tissue. In addition, thetreatment methods are safer and more effective than prior arttreatments. A treatment can be used to contour or re-contour body fat,which can include non-invasive shaping, fat removal, andskin-tightening.

In one aspect, a method of treating a subcutaneous fat region isprovided. The method includes generating electromagnetic radiationhaving a fat-selective wavelength of about 1,200 nm to about 1,230 nmand delivering an average power density of less than or equal to 2.3W/cm² of the electromagnetic radiation to the subcutaneous fat regionfor at least 300 seconds. The method also includes cooling an epidermalregion and at least a portion of a dermal region overlying thesubcutaneous fat region for at least a portion of the at least 300seconds and causing necrosis of at least one fat cell in thesubcutaneous fat region.

In another aspect, a method of treating a subcutaneous fat region isprovided. The method includes generating electromagnetic radiationhaving a non-fat selective wavelength and delivering the electromagneticradiation to the subcutaneous fat region for at least 300 seconds. Themethod also includes cooling an epidermal region and at least a portionof a dermal region overlying the subcutaneous fat region for at least aportion of the at least 300 seconds and causing necrosis of at least onefat cell in the subcutaneous fat region. The method can further includedeliver an average power density of less than or equal to 4.0 W/cm² ofthe non-fat-selective electromagnetic radiation.

In some embodiments, the electromagnetic radiation is delivered in threeconsecutive time intervals. During a first time interval, thesubcutaneous fat region is exposed to the electromagnetic radiation at afirst power density. During a second time interval, the subcutaneous fatregion is exposed to the electromagnetic radiation while theelectromagnetic radiation decreases from the first power density to asecond power density. During a third time interval, the subcutaneous fatregion is exposed to the electromagnetic radiation at the second powerdensity. The first time interval is shorter than the sum of the secondtime interval and the third time interval.

In another aspect, a method of applying electromagnetic radiation to asubcutaneous fat region is provided. The method includes exposing thesubcutaneous fat region to the electromagnetic radiation having a firstpower density for a first time interval. During a second time interval,the first power density of the electromagnetic radiation is lowered to asecond power density while exposing the subcutaneous fat region to theelectromagnetic radiation. For a third time interval, the subcutaneousfat region is exposed to the second power density. The first timeinterval is shorter than the sum of the second and third time intervals.

In another aspect, an apparatus for applying electromagnetic radiationto a subcutaneous fat region is provided. The apparatus includes asource of electromagnetic radiation and a delivery device coupled to thesource. The apparatus also includes a controller configured to adjustthe source so that the subcutaneous fat region is exposed to theelectromagnetic radiation having a first power density for a first timeinterval, the first power density of the electromagnetic radiation islowered, during a second time interval, to a second power density whilethe subcutaneous fat region is exposed to the electromagnetic radiation,and the subcutaneous fat region is exposed at the second power densityfor a third time interval. The first time interval is shorter than thesum of the second and third time intervals.

In yet another aspect, a computer program product, tangibly embodied ina non-transitory computer-readable storage medium, is provided. Thecomputer program product contains instructions operable to cause a dataprocessing apparatus to control an optical device to deliverelectromagnetic radiation having a first power density for a first timeinterval to expose a subcutaneous fat region to the electromagneticradiation. The optical device can be controlled to lower, during asecond time interval, the first power density of the electromagneticradiation to a second power density while the subcutaneous fat region isexposed to the electromagnetic radiation. In addition, the opticaldevice can be controlled to deliver the electromagnetic radiation to thesubcutaneous fat region at the second power density for a third timeinterval. The first time interval is shorter than the sum of the secondand third time intervals. In some embodiments, the computer programproduct can receive information from one or more built-in sensors orfrom an operator about the thickness of a subject's overlying skin. Thecomputer program product can use the information to adjust the powerdensity applied to the subject accordingly.

In other examples, any of the aspects above can include one or more ofthe following features. The fat-selective wavelength of theelectromagnetic radiation can be about 875 nm to about 950 nm or about1175 nm to about 1250 nm. In some embodiments, the fat-selectivewavelength of the electromagnetic radiation is about 900 nm to about 940nm or about 1200 nm to about 1240 nm. In some embodiments, thenon-fat-selective wavelength is about 950 nm to about 1090 nm or about1100 nm to about 1160 nm. The non-fat-selective wavelength can be about950 nm to about 1180 nm.

In some embodiments, the electromagnetic radiation is delivered to thesubcutaneous fat region for about 300 seconds to about 400 seconds. Insome embodiments, the electromagnetic radiation is delivered to thesubcutaneous fat region greater than or equal to 3 mm below a surface ofskin. At least one fat cell can be damaged so that lipid containedwithin can escape and at least a portion of the lipid can be carriedaway from the subcutaneous fat region.

In some embodiments, the electromagnetic radiation is delivered to thesubcutaneous fat region for about 20 minutes to about 30 minutes. Theelectromagnetic radiation can be delivered to the targeted treatmentregion via a body-fitting garment worn by the subject. The garment caninclude a means for delivering the electromagnetic radiation and/orbuilt-in laser diodes, light emitting diodes, or fiber-optics configuredto deliver light from a source. The source can be separate from thegarment or constructed into the garment. The garment can include acooling system for cooling the epidermis and parts of the dermis. Thegarment may be supplied as part of an exercising apparatus, in whichcase the time of electromagnetic heating can correspond to auser-selected exercising regiment.

In some embodiments, the electromagnetic radiation includes multiplepulses of electromagnetic radiation. If pulses of the electromagneticradiation are about 1210 nm, the average power density can be about 0.5W/cm² to about 2.5 W/cm². The peak power density can exceed 2.5 W/cm².

In some embodiments, the electromagnetic radiation includes multiplepulses of 925 nm electromagnetic radiation. The average power densitycan be about 0.5 W/cm² to about 3.5 W/cm². The peak power density canexceed 3.5 W/cm².

In some embodiments, the electromagnetic radiation includes multiplepulses of 1140 nm electromagnetic radiation. The average power densitycan be about 0.5 W/cm² to about 3.5 W/cm². The peak power density canexceed 3.5 W/cm².

In some embodiments, the electromagnetic radiation includes multiplepulses of 1064 nm electromagnetic radiation. The average power densitycan be about 0.5 W/cm² to about 4.0 W/cm². The peak power density canexceed 4.0 W/cm².

In some embodiments, the electromagnetic radiation includes multiplepulses of 975 nm electromagnetic radiation. The average power densitycan be about 0.5 W/cm² to about 3.5 W/cm². The peak power densityexceeds 3.5 W/cm².

In some embodiments, the average power density is adjusted based on athickness of skin overlying the subcutaneous fat region.

In some embodiments, the electromagnetic radiation is deliveredsimultaneously to a surface of skin overlying the subcutaneous fatregion and the surface of skin having an area of at least about 10 cm².

In various embodiments, the electromagnetic radiation is delivered inthe absence of precooling of the epidermal region and the portion of thedermal region overlying the subcutaneous fat region. In variousembodiments, the epidermal region and at least a portion of the dermalregion overlying the subcutaneous fat region is cooled duringelectromagnetic radiation delivery. The electromagnetic radiation can bedelivered in the absence of an anesthetic.

In some embodiments, a skin region overlying the subcutaneous fat regionis massaged prior to, during or after delivery of the electromagneticradiation.

In some embodiments, the sum of the first, second and third timeintervals can be greater than 300 seconds. The sum of the first, secondand third time intervals can be less than 300 seconds. The sum of thefirst, second and third time intervals can be about 165 seconds to about300 seconds.

In some embodiments, the first power density is about 4 W/cm², the firsttime interval is about 13 seconds, the second power density is about 2W/cm² and the sum of the second and third time intervals is about 92seconds. In some embodiments, the first power density is about 4 W/cm²,the first time interval is about 13 seconds, the second power density isabout 2 W/cm² and the sum of the second and third time intervals isabout 240 seconds.

In some embodiments, the first power density of the electromagneticradiation is lowered to the second power density in a continuous manner.In some embodiments, the first power density of the electromagneticradiation is lowered to the second power density in one or more discreteintensity levels.

In some embodiments, a temperature of at least a portion of a dermalregion overlying the subcutaneous fat region is below about 44° C.during at least one of the first, second or third time interval.

In some embodiments, the first time interval is shorter than the secondtime interval. In some embodiments, the subcutaneous fat region isexposed to the electromagnetic radiation at a third power density duringa fourth time interval, and the third power density is higher than thesecond power density but lower than the first power density. The thirdpower density of the electromagnetic radiation can be increased in acontinuous manner. The third power density of the electromagneticradiation can be increased in one or more discrete intensity levels. Thethird power density can be raised in a manner that is pain-tolerable tothe subject.

Other aspects and advantages of the invention will become apparent fromthe following detailed description, taken in conjunction with theaccompanying drawings, illustrating the principles of the invention byway of example only.

BRIEF DESCRIPTION OF THE DRAWINGS

The advantages of the invention described above, together with furtheradvantages, may be better understood by referring to the followingdescription taken in conjunction with the accompanying drawings. Thedrawings are not necessarily to scale, emphasis instead generally beingplaced upon illustrating the principles of the invention.

FIG. 1 shows a diagram of treatment parameters.

FIGS. 2A-2C show experimental and computational results for treatingfatty tissue.

FIGS. 3A-3C show experimental and computational results for treatingfatty tissue.

FIGS. 4A-1, 4A-2, 4A-3 and 4B show experimental and computationalresults for treating fatty tissue.

FIG. 5 shows tissue samples treated.

FIG. 6A-F show experimental and computation results for treating fattytissue.

FIG. 7 shows an exemplary embodiment of a system for treating fattytissue.

FIG. 8 shows another exemplary embodiment of a system that can be usedfor treating fatty tissue.

FIG. 9 shows an exemplary skin contacting portion of a delivery module.

DETAILED DESCRIPTION OF THE INVENTION

To reduce to the number of fat cells in biological tissue, radiation canbe used to treat the tissue by selectively heating the subcutaneous fatregion to induce fat necrosis without damaging the dermis and epidermis.Such treatment damages the fat cells so that lipid contained within canescape and at least a portion of the lipid can be carried away from atreatment region.

Based on the Arrhenius integral for predicting thermal damage, the onsetand amount of damage are dependent both on tissue temperature and thetime spent at that temperature. In particular, fat necrosis can becaused at lower power densities if exposure times are longer.Irradiation at lower power densities is advantageous because lower powerdensities generate lower temperatures, particularly in the dermis, whichare more pain tolerant to a subject. Therefore, during treatment, alower power density of radiation can be used, thereby decreasing thetemperature rise in tissue to a level that is tolerable to the subject.The power density can be maintained at that temperature for a timesufficient to cause the desired damage. Based on thermal models,viability studies with excised porcine skin, and preliminary dosing inhumans, a range of fluence rates and treatment durations have beenidentified that can be tolerated yet effective at inducing selectivenecrosis to subcutaneous fat while sparing the dermis and epidermis frominjury.

For example, laser treatment can involve keeping the temperature in thedermal region below about 44° C., which is below the threshold for type2 A-fiber nociceptors (the first heat-pain threshold occurring about 47°C.), while maintaining the temperature in the subcutaneous fat region toabout 50° C. or greater to cause damage to this region. The exposuretime is then determined by the Arrhenius time-temperature principle andcan be around 300 to 400 seconds for a treatment temperature of about50° C.

FIG. 1 shows an effective therapeutic range defined by curves 110 and114 for treating 2 mm-thick skin using a 1210 nm wavelength and atvarious exposure durations and power densities. The therapeutic range ofFIG. 1 is obtained in the absence of pre-cooling and with surfacecooling of 5° C. applied during treatment. To treat subcutaneous fat inthe 2 mm-thick skin without having to use anesthetics as a part of theprocedure, power density of about 2 W/cm² or less can be selected, whichis pain-tolerant to most subjects. Due to the low power density,exposure duration of about 300 s or greater can be used to satisfy thetime-temperature behavior described by Arrhenius. The pain-tolerantpower density can be dependent on skin thickness and the subject'stolerance to pain. Therefore the power density and the treatment timecan be adjusted accordingly. In some embodiments, the curves 110 and 114defining the effective therapeutic range change depending on whethercooling is applied before, during or after laser treatment and thetemperature at which the skin is cooled.

A clinical study was performed where the abdominal skin of humansubjects was treated using various durations of laser exposure atvarying power densities. For example, the square, diamond and trianglesymbols in FIG. 1 represent sample treatment data in human volunteerswhere fat necrosis was induced without causing adverse skin effects suchas full-thickness burns leading to ulceration.

In some embodiments, to minimize the treatment time, higher initiallaser powers can bring the temperature of tissue up quickly. To preventexceeding a predetermined temperature (e.g., about 44° C. in thedermis), the power density of the electromagnetic radiation can belowered and/or stepped down for a time period or the remainder of thetreatment period. This approach generates similar thermal damage zonesas the previous approach, but using a shorter treatment time. Anadditional increase in the treatment spot further decreases treatmenttimes by reducing the number of treatment spots needed to cover thetreatment area.

For example, the subcutaneous fat region of biological tissue is exposedto the electromagnetic radiation having a first intensity for a firsttime interval to quickly bring up the temperature of the subcutaneousfat region. The first intensity of the electromagnetic radiation is thenlowered, during a second time interval, to a second intensity whileexposing the subcutaneous fat region to the electromagnetic radiation.The subcutaneous fat region is exposed at the second intensity for athird time interval. The first time interval is shorter than a sum ofthe second and third time intervals, during which a higher initial laserpower density is used.

The treatment period, including the first, second and third timeintervals, can be at least 300 seconds. In some embodiments, thetreatment period is less than 300 seconds, such as about 165 seconds toabout 300 seconds. In general, the overall treatment time can be reduceddue to the initial elevation of power density during the first timeinterval. In addition, this treatment is pain tolerant to a subjectbecause the rise and fall of the initial power density is relativelyshort in comparison to the entire treatment period such that it isbearable to the subject. When providing treatment with a 4 cm diameterlaser beam, for example, the first power level can be about 50 W, andthe first time interval can be about 13 seconds, the second power levelcan be about 26 W, and the sum of the second and third time intervalscan be about 92 seconds.

The first intensity of the electromagnetic radiation can be lowered tothe second intensity in a continuous manner. The first intensity of theelectromagnetic radiation can be lowered to the second intensity in oneor more discrete intensity levels. The first time interval can beshorter than the second time interval. The first time interval can beshorter than the third time interval.

The temperature of the overlying skin tissue can be maintained belowabout 44° C. during at least one of the first, second or third timeinterval. The temperature of the overlying skin tissue can be maintainedbelow about 44° C. during at least two of the first, second or thirdtime interval. The temperature of the overlying skin tissue can bemaintained below about 44° C. during all three of the first, second andthird time intervals.

The biological tissue can be exposed to the electromagnetic radiation ata third power density during a fourth time interval. The third powerdensity can be higher than the second power density, but lower than thefirst power density. Such rise in power density at the end of the thirdtime interval is tolerable to a subject because the subject has alreadybuilt up a certain paint threshold caused by over-stimulated nociceptorsat that point during treatment. Hence, no additional pain is experiencedby the subject with the increase in power density. Such increase canfurther reduce the overall treatment time, which can be about 120seconds to about 300 seconds. The third power density of theelectromagnetic radiation can be increased in a continuous manner. Thethird power density of the electromagnetic radiation can be increased inone or more discrete intensity levels.

In some embodiments, a controller is used to automate the treatmentprocess. The controller can automatically initiate the radiationexposure sequence after detecting that the skin has established fullcontact with cooling plate, or if vacuum is used to draw the skin intocontact, when sufficient vacuum is applied to the skin of a subject. Thecontroller can dynamically select the power density and exposureduration for delivering electromagnetic radiation to a subcutaneous fatregion. If different power densities are used for different timeintervals during treatment, the controller can also automaticallydetermine the optimal power density and exposure time for each timeinterval.

In addition, the power density and exposure duration can be determinedbased on the thickness of the skin. The intensity of light reaching thesubcutaneous layer decreases with increasing overlying skin thicknessdue to increase light scattering and absorption in skin, so increasedpower is required to cause sufficient thermal damage in the subcutaneousfat. Therefore, the thickness of the skin can be measured over the areaof the body to be treated, such that the treatment fluence and exposuretime can be selected and controlled for each individual and the bodyarea to be treated. In some embodiments, skin thickness can be measuredusing ultrasonography at about 10 to 20 MHz for example.

The electromagnetic radiation can be delivered to the subcutaneousregion in the absence of anesthetic. The electromagnetic radiation canbe delivered to the subcutaneous region in the absence of pre-cooling ofthe epidermal region or the portion of the dermal region overlying thesubcutaneous region. In some embodiments, surface cooling is applied tothe epidermal region or the portion of the dermal region overlying thesubcutaneous region for at least a portion of the time during which thesubcutaneous fat region is treated with electromagnetic radiation.Surface cooling substantially prevents thermal damage to the superficialskin layers (epidermis and dermis). In some examples, the skin can becooled to about 0 to about 10° C. (preferably, about 5° C.) duringtreatment. Contact cooling or cryogen spray cooling can be used. Contactcooling can provide for cooling to deeper depths.

Surface cooling is accomplished with a sapphire optical window generallycooled to about 5° C. and placed in contact with skin. Vacuum suctioncan be applied to the skin surface to ensure good contact with thecooled sapphire window. A second optical window can create a coolingchamber between the two windows from which a refrigerant such as cooledFluorinert, cooled water, or another cryogenic fluid can flow.Atmospheric water vapor condenses on the outer surface of this coolingchamber, which can potentially absorb and scatter the laser treatmentbeam. Therefore, a third optical window can be used to form a secondchamber filled with a thermally insulating gas such as argon, krypton,dry nitrogen or vacuum to minimize condensation on the exterior window.Details regarding surface cooling are provided below with reference toFIG. 9.

The following example shows that longer treatment duration at a lowerpower density causes a similar zone of thermal fat damage when comparedto a shorter treatment duration at a higher power density. Yet, fortissues treated at the lower power density, the peak temperature in thedermis is much lower, thereby avoiding unbearable pain to a subject.

A finite element computer model was used to calculate temperature risesin tissues for 40 s and 120 s laser pulses and predict resulting tissuedamages. The model was designed for a collimated 40 mm diameter laserbeam incident onto the skin surface and includes a sapphire windowcooled to 5° C. A two-layer tissue geometry was used to model thermaland optical properties of dermis and subcutaneous fat. The size of thetissue slab was 70 mm×70 mm×10 mm. The thickness of the dermal layer isvariable and was typically set to 1.4 to 3 mm based on data collectedfrom human volunteers as shown in Table 1.

TABLE 1 Skin thickness measured in normal volunteers Mean +/− STD (mm)Gender Abdomen Upper Arm Posterior Thigh Flank Love Handle SubmentalNeck Male 2.4 +/− 0.4 1.8 +/− 0.4 2.2 +/− 0.4 3.2 +/− 0.6 2.5 +/− 0.61.7 +/− 0.1 Female 1.9 +/− 0.5 1.2 +/− 0.2 1.6 +/− 0.2 2.3 +/− 0.6 1.8+/− 0.4 1.5 +/− 0.4

FIG. 2A shows the time evolution of peak temperatures in dermis andsubcutis for 40 s and 120 s pulse durations. The applied laser power is46 W (3.66 W/cm²) and 29 W (2.31 W/cm²) for the 40 s and 120 s pulses,respectively. The 46 W and 29 W laser power is adjusted such that thethickness of the predicted thermal damage zone is similar, as shown inFIGS. 2B and 2C. FIG. 2B shows the thermal damage predicted for the 40 spulse duration and FIG. 2C shows the thermal damage predicted for the120 s pulse duration. For both pulse durations, the peak temperature issufficient to cause damage in the subcutaneous fat region while surfacecooling is sufficient to protect the dermis from damage. However, asshown in FIG. 2A, the peak dermal temperature 122 where a majority ofthe heat pain receptors reside is drastically reduced for the 120 spulse in comparison to the peak dermal temperature 124 for the 40 spulse. In addition, the peak dermal temperature 122 of the 120 s pulseis well below the first pain threshold 128 at 47° C.

Therefore, it is predicted that even though approximately the samedamage to the subcutaneous fat is caused by the two pulse durations, thelonger 120 s pulse duration is expected to be much less painful. Anotheradvantage of the longer 120 s pulse is that the zone of thermal damageis deeper in the subcutaneous fat region, thus forming a wider zone ofundamaged adipose tissue bordering the dermis. One disadvantage of usingthe longer 120 s pulse is a narrowing of the laser damage zone due tomore sideway thermal diffusion that occurs over longer times. Thisdisadvantage can be reduced by using larger diameter treatment beams.

Pain tolerance was verified from a number of volunteers. In general,subjects can take at most 20 s of the 40 s pulse before pain becameunbearable, while the entire 120 s pulse was easily taken by thesubjects, although some deep but tolerable pain was noted.

FIGS. 3A-C show the results of shortening the laser treatment time byusing a higher initial laser power to quickly bring up tissuetemperature, but preventing the temperature in the dermis from exceeding44° C. The temperature is then lowered to a second laser power for theremainder of the treatment period. One disadvantage of the approachdescribed above with reference to FIGS. 2A-C is that a longer treatmenttime is needed to cause sufficient thermal damage to tissue. To recoversome of the lost time, an approach is used that includes startingtreatment at a higher radiation power so as to raise temperaturequickly, then lowering the power intensity to avoid high and painfulpeak temperatures in the dermis.

FIGS. 3A-C compare the results from two treatment schemes. Bothtreatments are designed to cause similar zones of thermal damage aspredicted by a numerical model. The first treatment scheme treats tissueat a single power density, 2.1 W/cm² (26 W for a 40 mm spot) for 160 s.The second treatment scheme shortens the treatment time by 55 s byinitially using a higher treatment power density, 4.0 W/cm² (50 W for a40 mm spot) for 13 s. Then, to avoid exceeding 44° C. in the dermis, thetreatment power density is lowered to 2.1 W/cm² for 92 s.

FIG. 3A shows the time evolution of maximum temperatures at the dermisand adipose tissue for the two treatment schemes. FIGS. 3B and 3C showthe predicted damage zones for the first and second schemes,respectively. A comparison of FIGS. 3B and 3C reveals that the secondscheme causes sufficient and similar subcutaneous fat damage as thefirst scheme. FIG. 3A shows that the second scheme only uses about 13 sto raise the temperature of the dermis and subcutaneous adipose tissueto 44° C., while the first scheme takes about 60 s. In addition, thetotal treatment time required using the second scheme is 105 s while thefirst scheme takes about 160 s.

The second treatment scheme can include multiple discrete stepped-downpower levels or a continuous lowering of the laser power. In thisexample, the maximum dermal temperature drops rapidly once the power islowered. A more gradual drop in power can also be tolerable to a subjectand help to accelerate the rise in temperature in the subcutaneous fatregion, thus further shortening the treatment time in comparison tousing a more rapid drop. In some embodiments, the power is increasedafter a lowering period if pain is found to be tolerable. It has beenshown that pain at the first nociceptor threshold dulls over time, thusallowing for an increase in power applied.

Another example is provided to demonstrate that laser treatmentparameters can be customized to subject's skin thickness and toleranceto pain. The dependence of light distribution and resultant temperaturerise with dermal thickness. FIGS. 4A-1 to 4A-3 shows changes in zone ofthermal damage based on skin thickness when exposed to a 160 s laserpulse at 20 W to 32 W. In FIG. 4A-1, lighter zones 132 denotepanniculitis, i.e., inflammation of fatty tissue and most likelyapoptosis, while darker zones 136 denote necrosis. As shown, more lightreaches the subcutaneous fat layer for thinner dermis. Therefore, whenthe same laser power density is applied to skin of different dermalthickness, higher temperature and potentially more damage and pain ispredicted for thinner dermal thickness. Hence, laser output power andexposure duration can be selected based on a subject's dermal thicknessand his/her tolerance to pain. For example, laser power density can befirst adjusted to be as high as is tolerated by the subject. Then, theexposure duration can be selected to achieve the desired amount ofthermal damage.

Table 2 shows an exemplary calibration chart that provides the powerlevels and treatment durations for various dermal thickness to achievethe desired threshold for damage. The data in Table 2 is determinedbased on thermal modeling and measurements on ex-vivo porcine skin andlimited human data. As shown, lower power levels are required forthinner-skinned subjects to reach a similar threshold of fat damage asthicker-skinned subjects. However, because more light is capable ofreaching the subcutaneous fat region for thinner-skinned subjects, thetreatment times are not drastically effected. In some embodiments, ifpanniculitis, i.e., inflammation of fatty tissue occurs in the subject,increased treatment times in comparison to the times provided in Table 2are used.

TABLE 2 Relationship between laser power density and treatment timedepending on subjects' skin thickness Skin Thickness Laser Power DensityThreshold Treatment (mm) (W/cm²) Time for Damage (s) 1.4 1.83 145 1.91120 1.99 105 2.0 1.99 185 2.07 155 2.15 130 2.4 2.15 190 2.23 155 2.31135 3.0 2.55 140 2.63 125 2.71 110

In addition, FIG. 4B illustrates thresholds for necrosis for differentskin thickness. Curves 138 and 142 represent the thresholds for necrosisof subcutaneous fatty tissue for 1.5 mm and 2.5 mm thick skin,respectively. The curves are calculated based on finite-element modelsof 1210 nm radiation applied incidentally on skin surface withconcurrent 5° C. surface cooling. For the finite-element calculation, atwo-layer model is used with skin as the upper first layer and fattytissue as the lower second layer. Based on the two-layer model, astandard Monte Carlos simulation is used to determine the fractionalpercent absorption occurring within each volume element in the model.When combined with the incident fluence, the Monte Carlos simulation canbe used to compute the rate of heating in each volume element. In someembodiments, a curve representing an upper bound for necrosiscorresponding to each skin thickness can also be determined.

For every skin thickness, higher power densities at shorter exposuredurations, which are in the area to the left of the line 146, createmore superficial injury. In contrast, longer exposure times at lowerpower densities, which are in the area to the right of the line 146,create a deeper zone of injury.

In addition, data points represented by the solid circles in FIG. 4Bindicate the threshold of necrosis as measured by a lack of nitrobluetetrazolium chloride (NBTC) stains in laser-treated excised pig skin.Each excised skin sample was about 2 cm thick with dermis about 2 mm toabout 3 mm thick. Samples were placed on a hot plate heated to 35° C.before exposure to laser treatment. Data points represented by the soliddiamonds indicate the threshold of necrosis measured in live pigs.Necrosis in the subcutaneous fatty tissue of the pig tissue weredetermined based on biopsies taken two days following laser treatmentand staining with NBTC. Data points represented by the solid barsindicate the therapeutic range when treating abdominal skin in humanvolunteers for 40 s and 160 s exposures. The lowest end of each of thebars represents the lowest power density used where fat necrosis wasobserved. The uppermost end of each bar represents the highest powerdensity used before adverse skin effects are observed.

Yet another example is provided to show that thermal damage is dependenton both the applied laser power and the treatment duration time. In thisexample, laser damage was measured in freshly excised porcine skin. Skinsamples were cut to about 50 mm squares, each about 15 mm thick. Skinthickness was about 2 mm. Samples were warmed to 35° C. The samples arethen placed with skin side up on top of an aluminum hot plate and heatedto 35° C. The laser sequence was initiated by a foot switch pushedimmediately after a laser treatment handpiece was centered on thesamples and placed in contact with the skin surface. Samples weretreated with laser power densities varying from 1.9 W/cm² to 2.9 W/cm²(24 W to 36 W for 40 mm spot size) for 80 s to 200 s. In addition,surface cooling is applied during laser treatment of the samples.

Following the laser treatment, 40 mm by 7 mm slices were cut from thecenter of the laser treated area of each sample and placed in 4 ml of astock nitroblue tetrazolium chloride (NBTC) solution that was diluted1:5. The sample remained in solution for 3 hours at room temperature,after which the sample is removed and placed in 10% neutral bufferedformalin.

The NBTC-stained samples are shown in FIG. 5. Thermal damage isindicated by loss of staining due to the inability of NADPH-diaphorase(a mitochondrial enzyme) to reduce NBTC to a blue water insolublepigment, formazan. Hence, decreased staining corresponds to decreasedmitochondrial function, which indicates necrosis. As shown, a zone oflight NBTC staining can be observed in the samples 152, 154 treated at32 W (2.5 W/cm² for 40 mm spot size) for 160 s and 200 s and in thesamples 156, 158, 160 and 162 for all time durations when treated at 36W (2.9 W/cm² for 40 mm spot size). Therefore, the amount of thermaldamage is dependent on both the applied laser power and the treatmentduration time. In addition, good staining was observed in the dermis ofall the samples, demonstrating that the dermis is spared from damage bysurface cooling.

In another example, effective pain-tolerant power densities, peak dermaltemperatures, and depths of peak temperatures are provided for varioustreatment wavelengths and skin thickness. In particular, Table 3illustrates the effective pain-tolerant power densities, peak dermaltemperatures, and depths of peak temperatures for both fat-selective andnon fat-selective wavelengths and for skin thickness of 1.5 mm, 2.0 mm,and 2.5 mm. The laser exposure duration is about 280 seconds.

TABLE 3 Treatment parameters for various wavelengths and skin thickness1.5 mm skin 2.0 mm skin 2.5 mm skin Peak Peak Peak Peak Peak Peak PowerDermal Temp Power Dermal Temp Power Dermal Temp λ Density Temp DepthDensity Temp Depth Density Temp Depth (mm) (W/cm²) (° C.) (mm) (W/cm²)(° C.) (mm) (W/cm²) (° C.) (mm)  924* 3.2 38 4.9 3.4 40 4.7 3.4 41 4.5 975 3.5 42 4.7 1064 4.0 40 4.9 1140 3.0 42 4.5  1210* 2.1 43 3.7 2.2 433.7 2.3 43 3.7

In Table 3, the 924 nm and the 1210 nm wavelengths are fat-selectivewavelengths, which are preferentially absorbed by lipid cells. The 975nm, 1064 nm and 1140 nm wavelengths are non fat-selective wavelengths.As shown, the peak dermal temperature is below 44° C. for all treatmentwavelengths and skin thickness. In addition, the power density of theapplied can be adjusted based on skin thickness.

FIGS. 6A-F show temperature profiles and predicted thermal damage fortreating 2.0 mm-thick skin at various wavelengths and power densities.In particular, FIGS. 6A-B show the temperature profiles at various skindepths and predicted thermal damage, respectively, when the skin istreated at a power density of 4.0 W/cm² and a wavelength of 1064 nm,which is a non fat-selective wavelength. In FIG. 6A, temperatureprofiles 172, 174, 176, and 178 correspond to depth of 0.1 mm, 1.9 mm,4.9 mm, and 5.9 mm, respectively. FIGS. 6C-D show the temperatureprofiles at various skin depths and predicted thermal damage,respectively, when the skin is treated at a power density of 2.9 W/cm²and a wavelength of 1140 nm, which is also a non fat-selectivewavelength. In FIG. 6C, temperature profiles 182, 184, 186, and 188correspond to depth of 0.1 mm, 1.9 mm, 4.9 mm, and 5.9 mm, respectively.FIGS. 6E-F show the temperature profiles at various skin depths andpredicted thermal damage, respectively, when the skin is treated at apower density of 2.0 W/cm² and a wavelength of 1210 nm, which is afat-selective wavelength. In FIG. 6E, temperature profiles 192, 194,196, and 198 correspond to depth of 0.1 mm, 1.9 mm, 4.9 mm, and 5.9 mm,respectively. The profiles 178, 188 and 198 of FIGS. 6A, C and E,respective, demonstrate that the peak temperatures in the subcutaneousfat region for all the sample treatment parameters are about 50° C.,which is sufficient to cause thermal damage to the subcutaneous fatregion.

FIG. 7 shows an exemplary embodiment of a system 230 for treatingtissue. The system 230 can be used to non-invasively deliver a beam ofradiation to a target region. For example, the beam of radiation can bedelivered through an external surface of skin over the target region.The system 230 includes an energy source 232 and a delivery system 233.In one embodiment, a beam of radiation provided by the energy source 232is directed via the delivery system 233 to a target region. In theillustrated embodiment, the delivery system 233 includes a fiber 234having a circular cross-section and a handpiece 236. A beam of radiationcan be delivered by the fiber 234 to the handpiece 236, which caninclude an optical system (e.g., an optic or system of optics) to directthe beam of radiation to the target region. A user can hold ormanipulate the handpiece 36 to irradiate the target region. The deliverysystem 233 can be positioned in contact with a skin surface, can bepositioned adjacent a skin surface, can be positioned proximate a skinsurface, can be positioned spaced from a skin surface, or a combinationof the aforementioned. In the embodiment shown, the delivery system 233includes a spacer 238 to space the delivery system 233 from the skinsurface. A spacer 238 is not required however. In one embodiment, thespacer 238 can be a distance gauge, which can aid a practitioner withplacement of the delivery system 233.

Referring to FIG. 7, to minimize unwanted thermal injury to tissue nottargeted (e.g., an exposed surface of the target region and/or theepidermal layer), the delivery system 233 shown in FIG. 7 includes acooling system for cooling before, during or after delivery ofradiation, or a combination of the aforementioned. Cooling can includecontact conduction cooling, evaporative spray cooling (using a solid,liquid, or gas), convective air flow cooling, or a combination of theaforementioned. If cooling is used, it can cool the most superficiallayers of epidermal tissue. Cooling can facilitate leaving the epidermisintact.

FIG. 8 shows an exemplary embodiment of a system 301 that can be used toform a pattern of treatment zones in skin. System 301 can include a baseunit 305 coupled to an umbilicus 310, which is connected to a deliverymodule 315. The base unit 305 includes a power source 320 that suppliespower to an energy source 325. The base unit 305 also includes acontroller 330, which can be coupled to a user interface and can includea processing unit.

The system 301 can be used to non-invasively deliver an array ofradiation beams to a target region of the skin. For example, the arrayof radiation beams can be delivered through an external surface of skinover the target region. In one embodiment, a beam of radiation providedby the energy source 325 is directed via the delivery module 315 to atarget region. The umbilicus 310 can act as a conduit for communicatingpower, signal, fluid and/or gas between the base unit 305 and thedelivery module 315. The umbilicus 310 can include a fiber to deliverradiation from the base unit 305 to the delivery module 315. Thedelivery module 315 can include an optical system (e.g., an optic or asystem of optics) to convert the beam into an array of radiation beamsand direct the array to the target region. The delivery module 315 caninclude one or more laser diodes or light emitting diodes, or includeone or more optical fibers delivering light from a source such as laserdiodes. The optical system can include a mask or focusing system toprovide a beam of radiation having regions where no treatment radiationis delivered (e.g., to create a pattern of undamaged tissue or skinsurrounded by damaged tissue or skin). A user can hold or manipulate thedelivery module 315 to irradiate the target region. The delivery module315 can be positioned in contact with a skin surface, can be positionedadjacent a skin surface, can be positioned proximate a skin surface, canbe positioned spaced from a skin surface, or a combination of theaforementioned. In some embodiments, an array of radiation beams can beformed from a single beam of radiation by a system of optics.

In some embodiments, the base unit 305 can have a second source 332 ofradiation. For example, the source 325 can provide radiation that isabsorbed preferentially in the dermal skin region, and the second source332 can provide radiation that is absorbed preferentially in thesubcutaneous fat region.

To minimize unwanted thermal injury to tissue not targeted (e.g., anexposed surface of the target region and/or the epidermal layer), thedelivery module 315 can include a cooling module for cooling before,during or after delivery of radiation, or a combination of theaforementioned. Cooling can include contact conduction cooling,evaporative spray cooling, convective air flow cooling, or a combinationof the aforementioned.

FIG. 9 shows an exemplary skin contacting portion 340, which can be aportion of the system 230 attached to the handpiece 236 or the deliverymodule 315. The skin contacting portion 340 can include a coolantchamber 344 formed by two optical windows 348, 352 and sidewalls 354.Cooled refrigerant is passed through the flow chamber 344, cooling thewindow 348 that is in contact with a surface of skin 356, therebycooling the skin surface 356. One disadvantage of a one-chamber designis that it also cools the exterior of the windows 348, 352, which canlead to water droplets or frost forming on the exterior of the windows348, 352 due to condensation of atmospheric water vapor. Condensation isgenerated depending on the temperature of the refrigerant and relativehumidity. To avoid condensation, the skin contacting portion 340includes a third window 360 to form a second chamber 364 defined by thewindows 352, 360 and the sidewalls 354. The second chamber 364 can befilled with either a thermally insulating gas, such as argon, krypton,or dry nitrogen. In some embodiments, the second chamber 364 is fully orpartially evacuated.

The first optical window 348 can be made from a substance that has goodthermal conductivity such as crystalline sapphire. Each of the windows348, 352 and 360 can be a sapphire or glass window. All of the windows348, 352 and 360 as well as the chilled coolant fluid in the coolantchamber 344 can be transparent to the intended wavelength(s) of theapplied laser 368.

In some embodiments, the coolant chamber 344 can allow flow of chilledcoolant. The coolant can be chilled water, a fluorocarbon type coolingfluid such as chilled Fluorinert, a cryogenic fluid, or the like. Thecoolant can be transparent to the radiation used during treatment. Thecoolant chamber 344 can have sufficient flow to avoid a significantincrease in the water temperature in the chamber. The coolant chamber344 can be a thin chamber, which increases flow velocity. The coolantchamber 344 can include plenums and ports to avoid eddies within thechamber 344. For some laser wavelengths where the coolant can absorb thelaser radiation, the coolant chamber 344 can be made sufficiently thinto avoid excessive absorption of the laser energy by water in thechamber.

The second chamber 364 can be purged, filled with argon, and sealed.Alternatively, the second chamber 364 can be evacuated and filled withkrypton or some other thermally insulating gas.

The upper and lower surfaces of the window 360 can be coated with anantireflective film chosen to minimize reflection at the laserwavelength(s). The upper surface of the window 352, which is the surfacefacing the second chamber 364, can be coated with an antireflective filmchosen to minimize reflection at the laser wavelength(s).

In various embodiments, the energy source 332 can be an incoherent lightsource or a coherent light source (e.g., a laser). The energy source 332can be broadband or monochromatic. The beam of radiation can be a pulsedbeam, a scanned beam, or a gated continuous wave (CW) beam. The lasercan be a diode laser, a solid state laser, a fiber laser, or the like.An incoherent source can be a light emitting diode (LED), a flashlamp(e.g., an argon or xenon lamp), an incandescent lamp (e.g., a halogenlamp), a fluorescent light source, or an intense pulsed light system.The incoherent source can include appropriate filters to block unwantedelectromagnetic radiation.

In various embodiments, the wavelength of the electromagnetic radiationcan be about 400 nm to about 4000 nm, although longer and shorterwavelengths can be used depending on the application. In certainembodiments, the wavelength of the electromagnetic radiation is fatselective. For example, the ratio of coefficients of absorption of fatto water is about 0.5 or greater. The wavelength can be about 875 nm toabout 950 nm or about 1175 nm to about 1250 nm. For example, thewavelength can be about 900 nm to about 940 nm or about 1200 nm to about1240 nm. The wavelength can be about 1200 nm to about 1230 nm. In someembodiments, the wavelength is about 1210 nm. A first source operatingat about 1210 nm can be combined with a second source operating fromabout 400 nm to about 10.6 microns, with an RF source, or with anultrasonic source.

In some embodiments, the wavelength is non-fat selective, e.g., about950 nm to about 1090 nm, about 1100 nm to about 1160 nm, about 1,300 nmto about 1625 nm or about 1,800 nm to about 2,200 nm.

In some embodiments, the wavelength is selected to penetrate a surfaceof skin and reach the underlying subcutaneous fat region without beingabsorbed along the way so as to cause damage to the fat cells in thesubcutaneous fat region.

In various embodiments, an average power density of between about 0.5W/cm² to about 5 W/cm² of the electromagnetic radiation can be deliveredto the skin surface to treat the subcutaneous fat region for about 40seconds or longer, such as about 40 seconds to about 600 seconds. Insome embodiments, the average power density is less than or equal toabout 2 W/cm², such as about 0.5 W/cm² to about 2 W/cm². In someembodiments, the radiation is delivered to the subcutaneous fat regionfor at least about 300 seconds, such as about 300 seconds to about 400seconds. The peak power density of the applied radiation can exceed 2W/cm², as long as the average power density over a treatment period isless than or equal to about 2 W/cm². In some embodiments, multiplepulses of radiation can be delivered to the subcutaneous fat region andthe sum of the pulse durations reaches the desired treatment duration.

In various embodiments, the beam of radiation can have a fluence ofabout 50 J/cm² to about 1500 J/cm², although larger or smaller fluencecan be used depending on the application. The laser power can be about 5W to about 100 W, although higher or lower power can be used dependingon the application. In some examples, the laser power can be about 20 Wto about 50 W depending on the size of the treatment zone, thus allowingbetween about 0.5 W/cm² to about 2 W/cm² to be delivered to the skinsurface.

In various embodiments, the beam of radiation can have a spot sizebetween about 10 mm and about 60 mm, although larger and smaller spotsizes can be used depending on the application. In some examples, thespot size is rectangular and about 50 mm by 100 mm in dimension. Incertain embodiments, the radiation is delivered simultaneously to asurface of skin overlying the subcutaneous fat region. The surface ofskin can have an area of at least 10 cm².

Radiation can be applied to the skin in a stamping mode or by scanning alight source along a surface of the skin. A computerized patterngenerator can be used or a handpiece can be manually manipulated to scanthe light source.

In various embodiments, the parameters of the radiation can be selectedto deliver the beam of radiation to a predetermined depth. In someembodiments, the beam of radiation can be delivered to the target regionabout 0.005 mm to about 10 mm below an exposed surface of the skin,although shallower or deeper depths can be selected depending on theapplication. In some embodiments, the depth is about 1 mm to about 3.5mm. In some embodiments, the depth is greater than or equal to 3 mmbelow the surface of skin, where the subcutaneous fat region resides.

In various embodiments, the subcutaneous fat region can be heated to atemperature of between about 47° C. and about 80° C., although higherand lower temperatures can be used depending on the application. In oneembodiment, the temperature is between about 50° C. and about 55° C. Inone embodiment, the temperature is about 50° C.

In various embodiments, the beam of radiation can have exposure durationbetween about 3 s and about 1800 s, although longer and shorter exposuredurations can be used depending on the application. In some embodiments,the beam of radiation can have exposure duration of at least 300seconds, such as about 300 seconds to about 400 seconds. In someembodiments, a longer exposure time permits a beam of radiation to treatat a greater depth into the subcutaneous fat region in comparison to abeam of radiation having a shorter exposure time, providing that allother parameters are the same. In certain examples, if the powerintensity is sharply increased and then lowered during several timeintervals, the treatment duration is less than 300 seconds, such asabout 140 seconds to about 300 seconds. The treatment time can be evenshorter if the power intensity is increased slightly after the loweringperiod.

An optical system can be used to deliver radiation to a large area beamor as a pattern of beamlets (e.g., a plurality of microbeams having aspotsize of about 0.1-2 mm) to form a pattern of thermal injury withinthe biological tissue.

One or more sensors can be positioned relative to a target region ofskin. For example, a sensor can be positioned in contact with, spacedfrom, proximate to, or adjacent to the skin target. A sensor candetermine a temperature on a surface of the target region, in the targetregion, or remote from the target region. The sensor can be athermistor, an array of thermistors, a thermopile, a thermocouple, athermometer, a resistance thermometer, and a thermal-imaging basedsensor, a thermographic camera, an infrared camera or any combination ofthe aforementioned.

Processors suitable for the execution of computer programs include, byway of example, both general and special purpose microprocessors, andany one or more processors of any kind of digital computer. A processorcan receive instructions and data from a read-only memory or a randomaccess memory or both. A processor also includes, or be operativelycoupled to receive data from or transfer data to, or both, one or moremass storage devices for storing data, e.g., magnetic, magneto-opticaldisks, or optical disks. Data transmission and instructions can alsooccur over a communications network.

Information carriers suitable for embodying computer programinstructions and data include all forms of non-volatile memory,including by way of example semiconductor memory devices, e.g., EPROM,EEPROM, and flash memory devices; magnetic disks, e.g., internal harddisks or removable disks; magneto-optical disks; and CD-ROM and DVD-ROMdisks. The processor and the memory can be supplemented by, orincorporated in special purpose logic circuitry.

The treatment radiation can damage one or more fat cells so that atleast a portion of lipid contained within can escape or be drained fromthe treated region. At least a portion of the lipid can be carried awayfrom the tissue through biological processes. In one embodiment, thebody's lymphatic system can drain the treated fatty tissue from thetreated region. In an embodiment where a fat cell is damaged, the fatcell can be viable after treatment. In one embodiment, the treatmentradiation can destroy one or more fat cells. In one embodiment, a firstportion of the fat cells is damaged and a second portion is destroyed.In one embodiment, a portion of the fat cells can be removed toselectively change the shape of the body region.

In some embodiments, the beam of radiation can be delivered to thetarget region to thermally injure, damage, and/or destroy one or morefat cells. For example, the beam of radiation can be delivered to atarget chromophore in the target region. Suitable target chromophoresinclude, but are not limited to, a fat cell, lipid contained within afat cell, fatty tissue, a wall of a fat cell, water in a fat cell, andwater in tissue surrounding a fat cell. The energy absorbed by thechromophore can be transferred to the fat cell to damage or destroy thefat cell. For example, thermal energy absorbed by dermal tissue can betransferred to the fatty tissue. In one embodiment, the beam ofradiation is delivered to water within or in the vicinity of a fat cellin the target region to thermally injure the fat cell.

In various embodiments, treatment radiation can affect one or more fatcells and can cause sufficient thermal injury in the dermal region ofthe skin to elicit a healing response to cause the skin to remodelitself. This can result in more youthful looking skin and an improvementin the appearance of cellulite. In one embodiment, sufficient thermalinjury induces fibrosis of the dermal layer, fibrosis on a subcutaneousfat region, or fibrosis in or proximate to the dermal interface. In oneembodiment, the treatment radiation can partially denature collagenfibers in the target region. Partially denaturing collagen in the dermiscan induce and/or accelerate collagen synthesis by fibroblasts. Forexample, causing selective thermal injury to the dermis can activatefibroblasts, which can deposit increased amounts of extracellular matrixconstituents (e.g., collagen and glycosaminoglycans) that can, at leastpartially, rejuvenate the skin. The thermal injury caused by theradiation can be mild and only sufficient to elicit a healing responseand cause the fibroblasts to produce new collagen. Excessivedenaturation of collagen in the dermis causes prolonged edema, erythema,and potentially scarring. Inducing collagen formation in the targetregion can change and/or improve the appearance of the skin of thetarget region, as well as thicken the skin, tighten the skin, improveskin laxity, and/or reduce discoloration of the skin.

In various embodiments, a zone of thermal injury can be formed at orproximate to the dermal interface. Fatty tissue has a specific heat thatis lower than that of surrounding tissue (fatty tissue, so as the targetregion of skin is irradiated, the temperature of the fatty tissueexceeds the temperature of overlying and/or surrounding dermal orepidermal tissue. For example, the fatty tissue has a volumetricspecific heat of about 1.8 J/cm³ K, whereas skin has a volumetricspecific heat of about 4.3 J/cm³ K. In one embodiment, the peaktemperature of the tissue can be caused to form at or proximate to thedermal subcutaneous fat interface. For example, a predeterminedwavelength, fluence, pulse duration, and cooling parameters can beselected to position the peak of the zone of thermal injury at orproximate to the dermal subcutaneous fat interface. This can result incollagen being formed at the bottom of the dermis and/or fibrosis at orproximate to the dermal interface. As a result, the dermal interface canbe strengthened against fat herniation. For example, strengthening thedermis can result in long-term improvement of the appearance of the skinsince new fat being formed or untreated fat proximate the dermalinterface can be prevented and/or precluded from crossing the dermalinterface into the dermis. Targeted heating at the dermal subcutaneousfat interface can also affect the base of eccrine and/or apocrine glandsto reduce sweating, thus helpful to subjects with hyperhidrosis.

In one embodiment, fatty tissue is heated by absorption of radiation,and heat can be conducted into dermal tissue proximate the fatty tissue.The fatty tissue can be disposed in the dermal tissue and/or can bedisposed proximate to the dermal interface. A portion of the dermaltissue (e.g., collagen) can be partially denatured or can suffer anotherform of thermal injury, and the dermal tissue can be thickened and/or bestrengthened as a result of the resulting healing process. In such anembodiment, a fat-selective wavelength of radiation can be used.

In one embodiment, water in the dermal tissue is heated by absorption ofradiation. The dermal tissue can have disposed therein fatty tissueand/or can be overlying fatty tissue. A portion of the dermal tissue(e.g., collagen) can be partially denatured or can suffer another formof thermal injury, and the dermal tissue can be thickened and/or bestrengthened as a result of the resulting healing process. A portion ofthe heat can be transferred to the fatty tissue, which can be affected.In one embodiment, water in the fatty tissue absorbs radiation directlyand the tissue is affected by heat. In such embodiments, a waterselective wavelength of radiation can be used.

In various embodiments, a treatment can cause minimal cosmeticdisturbance so that a subject can return to normal activity following atreatment. For example, a treatment can be performed without causingdiscernible side effects such as bruising, open wounds, burning,scarring, or swelling. Furthermore, because side effects are minimal, asubject can return to normal activity immediately after a treatment orwithin a matter of hours, if so desired.

In various embodiments, an ultrasound device can be used to measure thedepth or position of the fatty tissue. For example, a high frequencyultrasound device operating at 10 MHz to 20 MHz can be used. A handpieceof an ultrasound device can be placed proximate to the skin to make ameasurement. In one embodiment, the ultrasound device can be placed incontact with the skin surface. The ultrasound device can deliverultrasonic energy to measure position of the dermal interface, so thatradiation can be directed to the interface.

The time duration of the cooling and of the radiation application can beadjusted so as to maximize the thermal injury to the vicinity of thedermal interface or overlying epidermal and dermal tissue. For example,if the position of the fatty tissue is known, then parameters of theoptical radiation, such as pulse duration and/or fluence, can beoptimized for a particular treatment. Cooling parameters, such ascooling time and/or delay between a cooling and irradiation, can also beoptimized for a particular treatment. Accordingly, a zone of thermaltreatment can be predetermined and/or controlled based on parametersselected. For example, the zone of thermal injury can be positioned inor proximate to the dermal interface.

In various embodiments, the skin in the target region or adjacent to thetarget region can be massaged and/or vibrated before, during, and/orafter irradiation of the target region of skin. The massage can be amechanical massage or can be manual massage. A handpiece can includerollers to massage the skin. Radiation can be delivered through acentral portion of the handpiece. The massage handpiece can be adaptedto fit over the delivery system shown in FIG. 6. In one embodiment, adelivery system can be formed with a mechanical massage device affixed.In one embodiment, vacuum can be used to pull the tissue into thedevice, which can provide an additional massage effect. In oneembodiment, a person massages the target region of skin afterirradiation of the tissue. Massaging the target region of skin canfacilitate removal of the treated fatty tissue from the target region.For example, massaging can facilitate draining of the treated fattytissue from the treated region. Vibrating and/or massaging the skin inthe target region or adjacent to the target region during irradiationcan reduce or alleviate treatment pain and allow treatment using higherpower densities.

In various embodiments, vacuum can be used to ensure that the skinsurface through which the treatment beam passes is in good contact withthe sapphire cooling window during surface cooling. This ensures safertreatment. In addition, vacuum can be used to hold the treatmentapplicator in place, thereby providing hand-free treatment. This isparticularly useful when treatment times are long.

While the invention has been particularly shown and described withreference to specific illustrative embodiments, it should be understoodthat various changes in form and detail may be made without departingfrom the spirit and scope of the invention.

What is claimed is:
 1. An apparatus for treatment of a subcutaneous fatregion, comprising: a source of electromagnetic radiation generatingelectromagnetic radiation having a non-fat selective wavelength; adelivery system coupled to the source of electromagnetic radiation andconfigured to deliver the electromagnetic radiation to the subcutaneousfat region for at least 300 seconds; and a controller configured toadjust an average power density based on a thickness of skin overlyingthe subcutaneous fat region, and to cause necrosis of at least one fatcell in the subcutaneous fat region, wherein the non-fat selectivewavelength is 950 nm to 1090 nm, 1100 nm to 1160 nm, 1,300 nm to 1625nm, or 1,800 nm to 2,200 nm.
 2. The apparatus according to claim 1,wherein the controller is constructed and arranged to deliver theelectromagnetic radiation to the subcutaneous fat region in threeconsecutive time intervals including: a first time interval during whichthe subcutaneous fat region is exposed to the electromagnetic radiationat a first power density; a second time interval during which thesubcutaneous fat region is exposed to the electromagnetic radiationwhile the electromagnetic radiation decreases from the first powerdensity to a second power density in a continuous manner; and a thirdtime interval during which the subcutaneous fat region is exposed to theelectromagnetic radiation at the second power density, wherein the firsttime interval is shorter than the sum of the second time interval andthe third time interval.
 3. The apparatus according to claim 1, whereinthe controller is constructed and arranged to adjust the electromagneticradiation power density from the first power density to a second powerdensity in a discrete manner.
 4. The apparatus according to claim 1,wherein the controller is constructed and arranged to deliver theelectromagnetic radiation to the subcutaneous fat region for at least300 seconds, to cause a peak temperature within the subcutaneous fatregion, resulting in necrosis of the at least one fat cell.
 5. Theapparatus according to claim 1, wherein the delivery system includes afiber having a circular cross section and a handpiece.
 6. The apparatusaccording to claim 5, wherein the handpiece includes a coolant chamberformed by two optical windows and sidewalls and, in order to avoidcondensation of atmospheric water vapor, the handpiece includes a thirdwindow to form a second chamber filled with either a thermallyinsulating gas or dry nitrogen.
 7. The apparatus according to claim 6,wherein the thermally insulting gas is argon or krypton.
 8. Theapparatus according to claim 4, wherein a cooling arrangement isconfigured to cool an epidermal region and at least a portion of adermal region overlying the subcutaneous fat region for at least aportion of the at least 300 seconds.
 8. The apparatus according to claim5, wherein the handpiece includes rollers to massage the skin.
 9. Theapparatus according to claim 1, wherein the average power density is 0.5W/cm² to 2.5 W/cm².
 10. The apparatus according to claim 1, wherein thedelivery system is constructed and arranged to deliver theelectromagnetic radiation simultaneously to a surface of skin overlyingthe subcutaneous fat region, the surface of skin having an area of atleast 10 cm².
 11. The apparatus according to claim 1, wherein thenon-fat selective wavelength is 975 nm, 1064 nm or 1140 nm wavelength.12. The apparatus according to claim 1, wherein the delivery system isconstructed and arranged to deliver the electromagnetic radiation asmultiple pulses of electromagnetic radiation.
 13. The apparatusaccording to claim 1, wherein the apparatus further comprises additionalsources of electromagnetic radiation and sources of RF and an ultrasonicsource.
 14. An apparatus for treating a subcutaneous fat region,comprising: a source of electromagnetic radiation having wavelengthswith ratio of coefficients of absorption of fat to water of at least0.5; a delivery device coupled to the source of electromagneticradiation; and a controller configured to adjust the source ofelectromagnetic radiation so as: (i) to expose the subcutaneous fatregion to the electromagnetic radiation having a first power density fora first time interval, (ii) (ii) to lower the first power density of theelectromagnetic radiation lowered, during a second time interval, to asecond power density while the subcutaneous fat region is exposed to theelectromagnetic radiation, and (iii) (iii) to expose the subcutaneousfat region to the second power density for a third time interval,wherein the first time interval is shorter than the sum of the secondand third time intervals, wherein the first time interval is shorterthan a sum of the second and third time intervals.
 15. The apparatusaccording to claim 14, wherein the source of electromagnetic radiationgenerates radiation with non-fat selective and fat selectivewavelengths.
 16. The apparatus according to claim 15, wherein thenon-fat selective wavelengths are 950 nm to 1090 nm, 1100 nm to 1160 nm,1,300 nm to 1625 nm, or 1,800 nm to 2,200 nm.
 17. The apparatusaccording to claim 15, wherein the fat selective wavelengths are 875 nmto 950 nm, or 1175 nm to 1250 nm.
 18. The apparatus according to claim17, wherein the fat selective wavelengths are 900 nm to 940 nm or 1200nm to 1240 nm.
 19. The apparatus according to claim 14, wherein thedelivery device is constructed and arranged to deliver theelectromagnetic radiation as multiple pulses of electromagneticradiation.